I haven't been to a doctor in years outside occasional emergency trips. How do you bring this up without seriously. I don't want to come off as the guy who compulsively self diagnoses based off what they read on the internet.
The initial appointment is probably going to be an in-depth interview with the specialist, coupled with filling out some self-assessments and, possibly, getting somebody who knows you well to fill out an assessment as well. (Apparently people with ADHD usually drastically underestimate their own symptoms, which is why a third-party perspective is important.)
After I got diagnosed, the specialist gave me useful advice, learning materials and resources, including recommendations for psychiatrists to reach out to for treatment. This is pretty important because a combination of psychiatric treatment with learning new skills, coaching... works better than only doing one or the other.
If you can afford it or it works well with your insurance, I would highly recommend reaching out to a specialist instead of (or in addition to) talking to a normal doctor.
This was an extremely meaningful datapoint for me in feeling "seen". One of the steps was to ask my mother to fill in a survey recalling how she experienced me as a child.
When I told my mother it was for ADHD diagnosis she laughed, and said, "You didn't have ADHD. You just liked to run around. In my experience 10% of kids are just wired that way."
Cue the psychiatrist telling me that ADHD prevalence is now thought to be around around 10%.
A good psychiatrist will not diagnose you with ADHD unless you have it, and they will not sit on the fence and say "maybe" if they believe you have it. Mine was emphatic with me.
> Apparently people with ADHD usually drastically underestimate their own symptoms, which is why a third-party perspective is important
Absolutely! The way people experienced me was totally different to the way I thought that they did.
This is very true. And it's not even just due to lack of access to mental health care as a child: everyone over a certain age will have grown up before "ADHD" was a recognized disorder, and thus couldn't have been diagnosed with it no matter what their symptoms were.
When you're a kid it's not that bad cos you have structure provided for you and little to no responsibility. You're just a constant pain in the ass. That's why it's named after all the things that piss people off about it and not named after what the lived experience is like or how it affects us internally. When you're an adult and you are responsible for structure and getting things done and holding down job it can silently and slowly crush you. It's a much bigger problem once you're an adult.
Not as much with inattentive-subtype. Then you just spend lots of time reading and are somewhat disorganized.
Until you get to adulthood.
This is the DSMV criteria: https://www.cdc.gov/ncbddd/adhd/diagnosis.html
Doctors are typically screening with a quiz that looks something like this: https://psychcentral.com/quizzes/adhd-quiz/
It's perfectly reasonable to say "I think I may have ADHD based on what I've read online, my symptoms match and people who know me have suggested I try adderall".
Some doctors are fine with letting everyone have stimulants, because they're pretty harmless unless you're really binging on them, and they won't give you enough to do that for very long.
Other doctors would prefer to put you on an SSRI or SNRI or wellbutrin or some other "non-addictive" medication (which ironically are more addictive, dangerous, and less effective), so avoid those IMO. You may have to shop around a bit, but your primary care doctor technically can write the prescription, but some prefer not to and you might need to find a specialist.
Contraindications for stimulants are if the patient has a history of heart conditions, complains about racing heart rate, excessive sweating, trouble sleeping, trouble eating, etc.
You generally want to start with a low dose of "instant release" as opposed to "extended release" pills, so you can have more fine grained control over the dose. IR pills can be broken in half, XR cannot. Some doctors are more nervous about IR than XR because they think it has more abuse potential (not true, but it's a common belief).
With all that said, stimulants will fix the problems OP described, but don't mistake that for a pleasant experience. The truth is that amphetamines are extremely mentally exhausting, and if you don't take good care of yourself (planning proper meals, staying hydrated, resting at appropriate times, not taking more pills when you shouldn't), you can quickly spiral out of control. It's hard to explain to someone that doesn't do drugs, but stimulants can leave you feeling like a shell of yourself, and it's really disconcerting. It's sort of like being over-tired where you're awake but your judgment is clearly impaired and you don't feel like "you". If you stay on them long enough, you'll start to feel like a zombie just going through the motions (successfully, mind you), but without identity. I make sure to take weekends off to preserve their efficacy for the work week and to make sure I don't become too dependent.
I'd 100% recommend having stimulants in your toolkit, and chances are you're already supplementing with worse stimulants (like mountains of coffee or soda), so do give them a try, but be careful.
You can always take the XR pill apart and split it into blank capsules. Or you can just dump a little out and take it without the capsule.
For example two of the titrations of Concerta (XR methylphenidate) which I have experienced first-hand are a hard candy-like tablet, and the pharmacokinetic result is that you receive 25% of the dose within a couple of hours, and then over the course of the rest of the day the remaining 75% hits your bloodstream.
But I now take an XR lisdexamfetamine which looks like it would be possible to split into smaller doses, but it's a prodrug so it's a totally different experience.
I know it's a luxury some folks can't afford, but there really are a great range of optimised formulations of the treatments for ADHD out there, and rather than guessing yourself, it'll be better to have an honest conversation with your doctor about the ability to mix XR/IR in a way that works for you.
I'll second this. I've got an old friend and former coworker who clearly has serious ADHD and self medicates with tons of coffee/soda/cigarettes. He's killing himself and he knows it, but hates doctors and has a negative view of shrinks.
Anec-data: I cut out carbs and only eat during certain windows and that has done wonders for focus and stick-to-itiveness. Coffee and alcohol hit me extra hard, and I've cut back on them.
This describes me to a T. I will not take amphetamines of any kind, so what's the point?
> Anec-data: I cut out carbs and only eat during certain windows and that has done wonders for focus and stick-to-itiveness. Coffee and alcohol hit me extra hard, and I've cut back on them.
I've heard other people say this. I really need to try it.
Use decaf if you don't want the double whammy of an empty stomach and more coffee than you might otherwise drink to smash your brain with caffine.
> It's perfectly reasonable to say "I think I may have ADHD based on what I've read online, my symptoms match and people who know me have suggested I try adderall".
Spot on! (Except for suggesting a prescription: the doctor will be able to establish whether, for example, a prodrug like lisdexamfetamine is better than adderall, or methylphenidate might be a safer starting point (I believe it's been studied for longer).)
But yeah: there is zero shame in going to a doctor and stating that you are experiencing symptoms which you recently learned to be consistent with ADHD, and would like a professional opinion on the severity and potential treatment options. Reading the traits commonly associated with ADHD, you'd almost expect someone to have done a great deal of research about the topic.
> It's hard to explain to someone that doesn't do drugs, but stimulants can leave you feeling like a shell of yourself
I've found (40mg lisdexamfetamine, but also previously had IR/XR Adderall, 2x titrations of Concerta, and an abortive attempt at Medikinet which is a different XR timed release formulation of methylphenidate as I understand it) that this is true to an extent. I don't dose on the weekends and have found that Mondays are a blur. It's 4pm before I know it and I'm wired and working on spreadsheets well into the night.
The closest thing I can express to how I know the drug is effective is that there is almost a directional cone of focus which I need to very consciously redirect to a new area of focus. If someone comes to speak to me I'm able to context switch, but moving from one task to another can require effort.
When I didn't eat enough or appear to have a faster metabolisation of the drugs than normal, I can have a feeling of focus for focus's sake: I'm blind to what's going on around me and uncommunicative.
For me, however, in the main the medication has been a pleasant experience. It's helped me to regulate my moods and dark sides -- particularly under stress. This will not be the case for everyone, and a good doctor will be up front about the fact that your body will react differently to different drugs. They'll have a preferred starting point for treatment which they know well, but they will not be afraid to switch it up in order to find you a solution which works well.
BTW I'm really glad that you shared in as much detail as you did given the empathy I feel for OP's potential need to battle ADHD symptoms without treatment in order to even get to treatment. It's really kind of you and I'm glad there are so many people on HN who have been through similar experiences to me. After experiencing 30-odd years of thinking I was deficient in some way, feeling the resonance of other people's similar experiences has been a huge boon for me. So thanks.
IMO what you describe is common and the worst type of addictive. You get all of the withdrawal and none of the desirable effects.
Have you heard of anybody managing their condition with caffeine pills or nicotine lozenges?